Feature | November 01, 2013

Pre-Hospital Administration of Bivalirudin Improves Outcomes in Heart Attack Patients

Pre-hospital administration of bivalirudin improves outcomes in heart attack patients

November 1, 2013 — According to a new study, administering the blood thinner bivalirudin to patients experiencing an ST-elevation myocardial infarction (STEMI) in a pre-hospital setting can reduce the risk of death and major bleeding complications compared to heparin with optional use of glycoprotein IIb/IIIa inhibitors. Findings from the EUROMAX trial were reported at the 25th annual Transcatheter Cardiovascular Therapeutics scientific symposium (TCT 2013).
 
The EUROMAX trial evaluated the administration of anticoagulant therapy prior to hospital admission by an emergency medical team. The trial compared a heparin-based strategy (with or without glycoprotein IIb/IIIa receptor inhibitors (GPIs) to a bivalirudin-based strategy. The primary endpoint was a composite incidence of death or non-coronary-artery-bypass-graft related protocol major bleeding at 30 days, assessed by intention to treat. 
 
While bivalirudin has been compared to other blood thinners in hospital settings, the EUROMAX study is the first to evaluate these anticoagulant therapy options prior to hospital admission and in conjunction with newer P2Y12 inhibitors such as prasugrel and ticagrelor. The randomized, international, prospective, open-label ambulance trial enrolled 2,198 patients with STEMI and intended for primary percutaneous coronary intervention (PCI), presenting either via ambulance or to centers where PCI is not performed. 
 
Patients either received bivalirudin (n = 1,089) or heparin (n = 1,109) at guideline-recommended doses (with or without routine or bailout GPI). 
 
After 30 days, patients that received bivalirudin, as compared with the heparin group, experienced a significantly lower rate of death and major bleeding (5.1 percent versus 8.4 percent, respectively). The secondary composite outcome of death, reinfarction and major bleeding at 30 days was also reduced with bivalirudin (6.7 percent in the bivalirudin group compared to 9.1 percent in the heparin group). Despite a lower rate of bleeding complications in the bivalirudin-treated patients, the risk of acute stent thrombosis was higher in the bivalirudin group compared to the heparin group (1.1 percent versus 0.2 percent, respectively), findings that parallel those observed in the HORIZONS-AMI trial.
 
“The benefits of bivalirudin stemmed from a substantial reduction in major bleeding and were robust and consistent across subgroups, regardless of the adjunctive oral antiplatelet therapy or the arterial access route used for angioplasty,” said Philippe Gabriel Steg, M.D., director, coronary care unit, Hopital Bichat at Assistance Publique - Hôpitaux de Paris.
 
“Findings from EUROMAX provide important additional insights into the role of bivalirudin in the pre-hospital setting prior to primary PCI.”
 
For more information: www.crf.org, www.nejm.org

Related Content

Sci-image, Scimage, CVIS, CIIMS, Cpacs c-pacs, cardiovascular information system

Today's cardiovascular information systems need to incorporate all facets of the cardiology department, including subspecialties, to allow a complete picture of a patient's record. These data also need to be able to be shared with enterprise data systems, such as the electronic medical record (EMR). This image is from ScImage, illustrating the various aspects that integrate to make up a complete CVIS. 

 

Feature | September 29, 2016 | Val Kapitula, RT(R), PMP, CIIP
Cardiovascular Information and Imaging Systems (CVIS) have existed for many years in the dedicated sub-specialty area
Keystone Heart, TriGuard Embolic Protection Device, real-world results, PCR London Valves Conference 2016
News | Embolic Protection Devices| September 29, 2016
Keystone Heart Ltd. recently announced the safety and efficacy of the TriGuard Cerebral Embolic Protection device...
Neuravi, EmboTrap II stent retriever, thrombectomy device, acute stroke, European launch, CE Mark
News | Thrombectomy Devices| September 28, 2016
Neuravi recently announced Conformité Européenne (CE) Mark approval and launch of the company’s newly available...
Infinix 4D CT

Toshiba's Infinix 4D CT, which combines CT with angiography in the interventional lab.

Feature | Angiography| September 28, 2016 | Tom Watson BS, RCVT, Clinical Analyst, MD Buyline
One of the more significant advancements for interventional X-ray (IXR) in the past few years has been a significantl
TCT 2016, TCT.16, main arena, late breaking trials
Feature | Cath Lab| September 28, 2016
September 28, 2016 — The Cardiovascular Research Foundation (CRF) has announced the 11 late-breaking trials and 16 fi
Avinger, U.S. Department of Veterans Affairs, VA, Lumivascular technology, FSS Contract Award
News | Optical Coherence Tomography (OCT)| September 27, 2016
Avinger Inc. recently announced the company has received an FSS Contract Award from the U.S. Department of Veterans...
News | Pharmaceuticals| September 26, 2016
Nearly 2 out of 5 people with diabetes who could benefit from statin therapy to lower their risk of future heart attack...
Bard, Lutonix 014 DCB, drug-coated balloon, six-month endpoint, FDA IDE trial
Technology | Drug-Eluting Balloons| September 26, 2016
C. R. Bard Inc. announced the U.S. Food and Drug Administration (FDA) approved an Investigational Device Exemption (IDE...
smartphones, hospital tranfers, heart attack patients, JACC study, South Korea
News | Mobile Devices| September 23, 2016
Smartphone communication among medical teams at different hospitals can significantly reduce the time it takes for...
Robert M. Califf, FDA commissioner, future of cardiovascular medicine, JACC column
News | Business| September 23, 2016
Technology advances coupled with increased use of social media and personal devices could offer new possibilities for...
Overlay Init